Essay: Discussing a move into care with parents NOT capable of making their own decisions

Peter Silin, Special to The Province10.20.2011

Peter Silin has worked professionally for 30 years in all areas of aging, caregiving and seniors housing. He has been a national eldercare consultant and keynote speaker around North America. Mr. Silin is the Principal of Diamond Geriatrics, an eldercare consulting firm providing case management, counselling, consultation on seniors housing, advocacy, and mediation.

There may come a time when your parents or loved ones are no longer capable of making informed decisions about their needs for care or the safety and appropriateness of where they live. It is at this point you will have to step in. Before you take that step, you need to know if they are not able to make appropriate decisions, or if they are not willing to. If it is the latter, that is their right. You will need to learn to let go and take care of yourself. If you do not, you will burn out and end up with your own health problems, depression, or other concerns. Stepping back can be especially difficult for an only child, or when it goes against the values of your culture or community. If you are afraid your parents have dementia, a physician should be consulted. Several conditions that appear similar to dementia have reversible causes. Once these have been ruled out, educate yourself about dementia. Besides impairing memory, dementia also causes impairment in judgment, insight and decision-making ability. The result is that people are often not able to agree to changes. Once help has been initiated, they may be quite accepting of it. Most people struggle with guilt and grief when they realize they must begin telling their parents what has to happen. We hear the term “parenting my parents,” but this is not what you are doing. You are caring for someone with a disability, filling in the gaps which a disability has created. To be able to have the conversation you have to change how you think about yourself, your relationship with your parents, and what is “right.” Start this conversation at a time good for you all. Be ready to listen. Even with dementia, insight and judgment are not black and white. Often people have some understanding of their situation, and some degree of ability to reason.

You might be able to negotiate. “Let’s try it for a while,” or “Try it for a month and if you are not happy, you can return home.”

Often these conversations and decisions are a little bit of a dance — you push, then pull back, push and pull back. You might have to come back to the conversation several times.Talk to your doctor about possibilities and approaches, or hire a private geriatric care manager. We may be able to help you keep your parents at home, or guide you in making decisions. At some point, though, you just have to tell them, with compassion and caring, that “this is the way it is going to be.”Moving someone to seniors’ housing without their consent is more difficult. Legally, you may not have the right to do so, but ethically, you may have no choice about leaving them at home. Often a move comes about only after a fall or other event has led to hospitalization. There are resources to help you through your health authority, including geriatric mental health servicesYou may have to find housing on your own, without your parents’ involvement. If privately funded housing is not an option, contact your local health authority for an assessment and waitlisting. When the time comes, you may have to tell your parents they are moving. If it is to a nursing home, there have been times when people have had to go as far as telling their parent that they are going for lunch, and they go to the home. This is extreme and is often only done with the involvement of local health authorities and geriatric mental-health teams.

There are two paths to obtaining the legal authority to make personal or health-care decisions for someone. One is for the individual to give you that permission through a representation agreement. Representation agreements are the sole legal documents by which British Columbians are able to give permission for someone else to take over for them if necessary. They are generally made with the help of a lawyer but in some instances can be made with a notary public. If someone is not capable of making a representation agreement and is unable to make decisions for themselves, you will need to obtain what is called committee (with the accent on the last syllable) of person. This can only be obtained through the court and, if it is contested, can up end costing many thousands of dollars.In the absence of these documents, a family member may, in some cases, make decisions if a person is deemed unable to do so by a physician. The Office of the Public Guardian and Trustee is also legally empowered to become a temporary decision-maker under certain conditions. It is important to remember that if you have “power of attorney” for someone, it does not give you the right to make decisions about health or personal care — it only gives you power to make financial decisions.The journey to being the decision-maker for parents can be difficult and guilt-producing. Don’t do it alone. Find help from friends, support groups, private counsellors, or groups such as the Alzheimer’s Society. Look online for resources from forums.

My book, Nursing Homes and Assisted Living, specifically addresses this difficult transition and is written to help family members with the emotional as well as practical issues involved in moving to seniors’ housing.

Peter Silin, MSW, RSW, CCC, has worked professionally for 30 years in all areas of aging, caregiving and seniors’ housing. He has been a national eldercare consultant and keynote speaker around North America. Silin is the Principal of Diamond Geriatrics, an eldercare consulting firm providing case management, counselling, consultation on seniors housing, advocacy, and mediation. He is a well-known speaker, giving lectures and seminars to business and non-profits. His book, Nursing Homes and Assisted Living, is used throughout North America. He can be reached at eldercare@diamondgeriatrics.com or 604 874 7764.

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Essay: Discussing a move into care with parents NOT capable of making their own decisions

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